Georgia Medicaid Work Reqs Waiver Extended To December 2026

By Dorothy Mills-Gregg / September 23, 2025

The Trump administration agreed to extend until Dec. 31, 2026 Georgia’s waiver to partially expand Medicaid, letting the state continue its controversial work requirement program -- along with tweaks like moving from monthly to annual data reporting -- until the national requirements begin on Jan. 1, 2027.

CMS didn’t detail how Georgia’s 1115 waiver differs from the new national Medicaid work requirements set out by the One Big Beautiful Bill law, but it said the administration will partner with the Peach State on its preparations to ensure compliance and successful implementation of OBBB’s version of work requirements.

Georgia is the only state to have maintained its Medicaid work requirements waiver granted under the first Trump administration after the Biden administration tried in its first year to revoke all such Medicaid waivers granted by Trump’s CMS. After a two-year implementation delay due to the court battle with Biden’s CMS, Georgia managed to finally launch its program on July 1, 2023, but the Democratic administration refused the state’s request to run its partial Medicaid expansion for the previously agreed-upon five-year period. After another court appearance, Georgia was told it must terminate its Medicaid expansion as scheduled in 2025 or file an extension request to CMS with the requisite information.

The Peach State requested an extension, and on Tuesday (Sept. 23), the Trump administration announced it would extend by one year Georgia’s program along with its requested amendments.

These modifications to the program include considering as having met the work requirements beneficiaries who have met the Supplemental Nutrition Assistance Program requirements or who are caring for a child younger than six years old -- two exemptions to OBBB’s national work requirements as well.

Georgia’s amended waiver will also require less frequent reporting requirements, asking beneficiaries to submit their qualifying hours and activities on an annual basis rather than monthly.

However, CMS says, “the state will conduct random and periodic audits of beneficiary compliance with requirements in order to maintain program integrity and promote compliance with the eligibility requirements. This change is intended to improve beneficiary experience and reduce the administrative burden in implementing the program.”

The extension also cancels at Georgia’s request the state’s authority to create a member rewards account that offers certain beneficiaries incentives like modified copayments and premiums. The state never implemented such a rewards program, CMS’ waiver approval says.

Over the years, beneficiary advocates have criticized the demonstration for its poor enrollment -- 9,175 Georgians as of Aug. 31 -- and considerable cost -- nearly $110 million overall and about $18.4 million in state spending so far, according to the Georgia Budget & Policy Institute.

CMS acknowledged the dismal number of enrollees under the 1115 waiver in the administration’s approval letter. It said the 7,463 beneficiaries enrolled as of May 2025 “fell short” of Georgia’s projected 25,000 enrollees in the first year and 47,000 in the second year of implementation.

“The state’s draft Interim Evaluation Report attributes the low enrollment to several factors, such as a general lack of awareness and understanding of the program; a complex and administratively burdensome application process; and a limited set of exemptions and qualifying activities,” the letter says. “The change in beneficiary compliance reporting requirements from a monthly to an annual cadence approved through the amendment in this temporary extension is expected to relieve much of the administrative burden in the application process.”

Georgia has also allocated $10.7 million in American Rescue Plan funds to advertise its partially expanded Medicaid program, CMS says.